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Fall Pharm Block 2 > Diuretics > Flashcards

Diuretics Flashcards

1
Q

What were the first diuretics made from (no longer used)?

A

Mercury

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2
Q

What is the action of an osmotic diuretic?

A

Get into the renal tubules and suck water to them.

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3
Q

What is the primary use of manitol?

A

Decrease cerebral edema in patients with inc ICP

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4
Q

What is the formula to determine cerebral perfusion pressure?

A

CPP = MAP - ICP

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5
Q

What is the mechanism of action of glycerin and why do people take it?

A

Osmotic diuretic. Body builders use it as a PED to enhance muscle definition

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6
Q

What is the mechanism of action of aquaretics?

A

Increases urination by antagonizing ADH.

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7
Q

What condition is aquaretics used to treat? What causes said condition and what is the first sign or symptom?

A

Syndrome of Inappropriate ADH (SIADH)
SIADH is caused by tumors, TBI, or brain CA)
1st sign of SIADH is hyponatremia

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8
Q

What aquaretic is used in the treatment of SIADH and what kind of drug is it?

A

Demeclcycline - tetracyclic antibiotic that is not used as an antibiotic.

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9
Q

What is the mechanism of action of aquaretics?

A

Increase urination by antagonizing ADH

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10
Q

Describe the genesis of carbonic anhydrase inhibitors.

A

It was noted that some sulfur compounds produce mild diuresis characterized by highly alkaline urine.

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11
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A

Carb anhydrase is an enzyme in high concentration in the kidneys responsible for reabsorption of HCO3. Blockade causes HCO3 and water to stay in urine.

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12
Q

What is a significant adverse event associated with carbonic anhydrase inhibitors?

A

Can cause severe hypokalemia

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13
Q

What is the main role for carbonic angydrase inhibitors today and by what mechanism of action?

A

Glaucoma eye drops: Decrease aqueous humor production and decrease intraocular pressure.

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14
Q

What class of medication is acetazolamide and what is its primary use?

A

CAI - glaucoma eye drops

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15
Q

What is the second most common use of acetazolamide and by what mechanism?

A

altitude sickness: mild dec in serum pH causes Hgb to more easily discharge oxygen.

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16
Q

What is an infrequent use of acetazolamide and by what mechanism?

A

Anti-seizure: theorized that mild acidosis makes it more difficult for CNS to fire and cause a seizure.

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17
Q

What class of medications is first line for diuresis?

A

Thiazides

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18
Q

What is the mechanism of action of thiazides?

A

Act at the distal tubule to prevent reabsorption of sodium, and thus, water.

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19
Q

What was the first thiazide?

A

Chlorothiazide

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20
Q

How would one describe the efficacy of thiazides?

A

Medium efficacy

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21
Q

What is the affect of thiazide diuretics in patients with low creatinine clearance?

A

Essentially no efficacy: thiazides will not reach the distal tubule if kidney function is decreased.

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22
Q

What class of drugs do thiazides have cross sensiticity with?

A

sulfonamides (thia means sulfa in Latin). Use with caution in Pt’s with sulfa allergy.

23
Q

What is generally true about the pharmacokinetics of thiazides?

A

Fast acting –> instruct Pt’s not to take close to bed time bc it will cause them to wake to urinate.

24
Q

What are the electrolyte effects of thiazides?

A

HypoK, Hyperuricemia, Hyperglycemia (very mild), HyperCa.

25
Q

Because of the electrolyte effects, what patients should not get thiazides?

A

Gout bc of hyperuricemia

26
Q

What patients benefit from the electrolyte effects of thiazides?

A

Menopausal women bc of hypercalcemia

27
Q

What is an adverse effect of thiazides?

A

Photosensitivity –> extra need for sunscreen

28
Q

What drug is first line treatment for hypertension and why?

A

Hydrochlorothiazide (HCTZ) bc it is generic = very cheap

29
Q

What is true about the efficacy of loop diuretics?

A

High efficacy with a high ceiling –> can keep going up on the dose.

30
Q

What are the three go to diuretics? Which is cheapest and used most often? Which is most potent?

A

Furosemide - cheapest and used most often
Bumetanide - highest bioavailability/potency
Torsemide

31
Q

What symptom may cause providers to move to a different loop diuretic other than furosemide?

A

Edema in GI tract (dec absorption) –> bumetanide and torsemide have higher bioavailability.

32
Q

What is true about the pharmacokinetics of furosemide?

A

Quick onset with duration of action of about 6 hours. Pt’s should not take close to bed time.

33
Q

What class of drugs might loop diuretics have some cross sensitivity with?

A

sulfonamides

34
Q

By what route(s) are loop diuretics available?

A

IV and PO

35
Q

What is the primary indication for loop diuretics?

A

CHF - high potency, high ceiling

36
Q

What are the electrolyte effects of loop diuretics?

A

hypoK, hypoCa, hyperuricemia, hyperglycemia

37
Q

What patients benefit from an electrolyte effect of loop diuretics?

A

Used to treat bone cancer bc they cause hypercalcemia.

38
Q

What is an adverse effect of loop diuretics caused by rapid IV administration of the drug?

A

ototoxicity - tinnitus, mild hearing loss, imbalance

39
Q

What ion is wasted whenever Na is wasted?

A

Lithium

40
Q

What is the mechanism of action of aldosterone antagonists?

A

waste Na and retain K

41
Q

What is the prototype aldosterone receptor antagonist?

A

Spironolactone

42
Q

What is true about the efficacy of aldosterone antagonists?

A

low efficacy diuretic

43
Q

What are the electrolyte effects of aldosterone antagonists?

A

hyperK (“K sparing”), no significant affect on glucose or uric acid.

44
Q

If a patient has gout and needs a diuretic, which are they most likely to be prescribed?

A

aldosterone antagonists bc they do not increase uric acid.

45
Q

What is an adverse effect of spironolactone and why?

A

painful gynecomastia: has estrogen effects - directly related to dose and duration of therapy.

46
Q

What aldosterone antagonist can be prescribed if a patient has painful gynecomastia on spironolactone?

A

Eplerenone

47
Q

Compare and contrast non-steroidal potassium sparing diuretics with aldosterone antagonists.

A

Both waste Na and retain K. Non-steroidals do it independent of aldosterone (a steroid).

48
Q

What is true about the efficacy of non-steroidal potassium sparing diuretics?

A

low efficacy

49
Q

What other diuretic are non-steroidal potassium sparing diuretics combined with and why?

A

HCTZ - non-steroidals counteract the hypoK of HCTZ

50
Q

Name 2 non-steroidal potassium sparing diuretcs and name the combo products with HCTZ.

A

Trimaterene - Maxzide and Dyazide are trimetarene + HCTZ

Amiloride - Moduretic is amiloride + HCTZ

51
Q

What drug is used to counteract the hypoK effects of many diuretics and how is it dosed and administered?

A

Kcl - many dosing strategies and PO and IV formulations

52
Q

How is KCl dosed and what is the typical starting dose?

A

dosed in mEq - start at 10 - 20 mEq

53
Q

What is the max IV replacement dose of K and why?

A

10 mEq/hr - need to give it time to get in the cell. Faster admin rates can cause hyperK

Fall Pharm Block 2 (8 decks)

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